SW6200903_Supplemental Info Review_20200924

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/24/2020 9:21:11 AM (Supplemental Submittal)
Submit by Gwinn, Matt 9/24/2020 10:15:31 AM (Supplemental Info Submittal)
• The task was assigned to Gwinn, Matt 9/24/2020 9:21 AM

Submittal Dated: 9/24/2020
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Existing Project Information:
Rease suDDly the Derrrit nunber for this urolect.
D# * Perrrit N irrber
SW6200903
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Winchester Subdivision
County: Hoke
Name: MICHAEL BLAKLEY
Vft is subrritting the infornation?
Email Address:* [e-mail]
Please upload all files that need to be submited.
click the upload button or drag and drop files here to attach docurrent
2020.07.20 - Post Storm Application.pdf 795.88KB
2020.09.14 SIA Report.pdf 9.93MB
2020.09.14-SuppEZ-2018-Version-2.1.1-2.pdf 270.53KB
DEED.pdf 1.35MB
Low Density Covenance.pdf 726KB
2020.09.14 - Winchester Subdivision CDs.pdf 23.06MB
Only pdf files are accepted.
Please alert us to any confidential information contained in the uploaded documents.
Uploads contain r NO
Confidential r YES
Information * NOTE The following inforrretion cannot be clairred as confidential: the narre and address of any perrrit applicant or
perrrittee, perrrit applications, pernits, effluent data, infornation required by MODES application forr s provided by
the Director inclusive of all forms and attachrrents [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
* V By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of the
NC General Statutes (the "Uniform Electronic Transactions Act")

I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* MICHAEL BLAKLEY
Signature:
Date Submitted: 09/24/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW6200903
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 09/24/2020